Provider Demographics
NPI:1679465785
Name:PENUNURI, MARCIA NICOLE
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:NICOLE
Last Name:PENUNURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 SIERRA BERMEJA DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-4299
Mailing Address - Country:US
Mailing Address - Phone:520-234-3478
Mailing Address - Fax:
Practice Address - Street 1:2479 SIERRA BERMEJA DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650
Practice Address - Country:US
Practice Address - Phone:520-234-3478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN186190163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management